Solution Design Guide V2 AMD

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Cisco HealthPresence
Solution Design Guide
Cisco HealthPresence Version 2.0 for AMD Telemedicine Medical Devices
November 16, 2011
Text Part Number: OL-25034-01
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Cisco HealthPresence Solution Design Guide
2011 Cisco Systems, Inc. All rights reserved.

iii
OL-25099-01
C O N T E N T S
Solution Design Guide
Overview 1-1
Objectives and Audience 1-1
Cisco HealthPresence Intended Uses 1-1
Cisco HealthPresence Capabilities 1-2
New Features in Cisco HealthPresence V2.0 1-3
Simplified Workflow and Ease of Use for Providers and Attendants 1-3
Business to Business (B2B) Capability 1-5
Infrastructure Enhancements 1-5
Versatility and Cost Effectiveness 1-5
Smaller, More Secure Form Factor 1-6
Simplified Installation and Support 1-6
Cisco HealthPresence Architecture 1-6
Cisco HealthPresence Components 1-7
Cisco HealthPresence Software Components 1-7
Video Conferencing Support 1-7
Video Endpoints 1-7
Call Control 1-8
Multi-point Bridges 1-8
Cisco HealthPresence-Supported Medical Devices 1-9
Furniture Options 1-10
Cisco HealthPresence Patient Pod 1-10
Cisco HealthPresence Clinical Presence Cart 1-10
Data Center Requirements 1-11
For Use with Specific Software and Hardware 1-12
Key Considerations 1-12
Designing the Solution 2-1
Data Center Deployment Models 2-1
Enterprise Deployment 2-2
Service Provider Deployments 2-2
Understanding the Features of Cisco HealthPresence 2-4
Multi-tenancy 2-4

Contents
iv
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B2B Server 2-4
B2B Groups 2-5
Achieving High Availability 2-6
Network Deployment Options 2-6
Overlay Network 2-7
Converged Network 2-7
Communication between Networks 2-7
Emergency Dialing System Design 2-7
Video Endpoint Considerations 3-1
Video Endpoints Supported 3-1
Unified Communication Models 3-2
Multipoint Bridge Options 3-2
Other Considerations 3-5
Video Endpoints and Furniture Choices 3-5
Video Endpoints and Bandwidth Requirements 3-5
Cisco HealthPresence Bandwidth Requirements and Quality of Service Recommendations 4-1
Bandwidth Requirements for Cisco HealthPresence Endpoints 4-1
Bandwidth Required for Streaming Video and Audio from AMD Medical Devices 4-2
Video Endpoint Bandwidth 4-2
Cisco TelePresence System 500 Bandwidth Requirements 4-2
Cisco TelePresence System EX60/EX90/Edge 95 and Cisco TelePresence C20/C40 Bandwidth
Requirements 4-3
Bandwidth Requirements for a Cisco HealthPresence Data Center 4-4
Quality of Service 4-4
QoS Best Design Practices for Cisco HealthPresence 4-5
Best Practices for Converged Networks 4-6
Marking Cisco HealthPresence Traffic 4-7
Cisco HealthPresence Security 5-1
Overview 5-1
Authentication / Access Control 5-1
Authentication Options 5-1
External LDAP-Authentication 5-1
Dedicated Cisco HealthPresence Authentication 5-2
Mixed Authentication 5-2
Cisco HealthPresence Security Policy 5-2
Security Policy Controls for Cisco HealthPresence-Authenticated User Names 5-2
Security Policy Controls for All Cisco HealthPresence User Names 5-2

Contents
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Other Authentication Security Features 5-3
Cisco HealthPresence Appliance Security 5-3
Transmission Security 5-4
Patient Privacy 5-4
Network Security 5-5
Using Firewalls in Converged Networks 5-5
Cisco HealthPresence and Cisco TelePresence TCP and UDP ports 5-5
Cisco HealthPresence Room Design and Physical Requirements 6-1
Physical Room Design and Requirements 6-1
Room Dimensions and Characteristics 6-1
Room Dimensions 6-1
Room Dimensions for Cisco HealthPresence Furniture Options 6-2
Ceiling Height 6-3
Door Locations 6-4
Windows 6-4
Heating, Ventilating, and Air Conditioning (HVAC) 6-4
Illumination 6-5
Considering Light Angles and Direction 6-5
Ideal Lighting Environment 6-6
Background Recommendations 6-6
Paint Colors 6-6
Chair Requirements 6-7
Cisco Services for Cisco HealthPresence 7-1
Challenge 7-1
Solution 7-1
The Cisco HealthPresence Plan, Design, and Implement Service 7-3
Software and Hardware Support and Maintenance 7-4
Cisco HealthPresence Custom Application Support (CAS) 7-4
Cisco SMARTnet 7-4
Cisco HealthPresence Application and Telemetry Support Service 7-5
Cisco HealthPresence Day 2 Managed Service Offerings 7-5
Cisco HealthPresence Remote Management Services (RMS) 7-5
Cisco HealthPresence Solution Support 7-6
Cisco HealthPresence Partner Delivered Day 2 Support Model 7-7
Cisco HealthPresence Customer Managed Day 2 Support Model 7-7
Cisco HealthPresence Workshop 7-8
Benefits 7-9

Contents
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Why Cisco Services 7-10
For More Information 7-10
C H A P T E R
1-1
1
Overview
Revised: November 16, 2011
Objectives and Audience
The Cisco HealthPresence Solution Design Guide provides an overview of the options and best
practices for designing a Cisco HealthPresence V 2.0 solution, including:
selecting a deployment model
choosing the features you want to use
designing the video conferencing portion of the solution
determining bandwidth requirements and implementing quality of service
determining security requirements and defining your security policy
designing a Cisco HealthPresence room
selecting Cisco service options
The target audience is Cisco HealthPresence solution planners and designers.
Cisco HealthPresence Intended Uses
The Cisco HealthPresence Solution consists of Attendant and Provider endpoints running the Cisco
HealthPresence-Connect software.
The Cisco HealthPresence Enterprise Server at a data center provides a communications link between
HealthPresence endpoints over private or virtual private network connections. Utilizing the network
connections with encryption, the Cisco HealthPresence-Connect software transmits data acquired from
third-party medical devices at an Attendant endpoint to Provider endpoints located within remote
facilities.
Compatible third party devices include the following medical devices from AMD Telemedicine
1
:
Digital stethoscope (AMD-3700)
1. This guide specifically covers Cisco HealthPresence when using medical devices supported in the United
States. Most of the solution design is the same regardless of the device aggregators and medical devices. The
Cisco HealthPresence Solution Design Guide Addendum for Neurosynaptic Devices addresses the solution
guidelines (in particular, bandwidth requirements) that are unique to medical devices not supported in the
United States.
1-2
Chapter 1 Overview
Cisco HealthPresence Capabilities
Camera and illumination system (AMD-400) and supported scopes:
Digital ear, nose, and throat video scope (AMD-2015)
Digital direct ophthalmoscope (AMD-2020)
Digital dermascope (AMD-2030)
Digital examination camera (AMD-2500)
Vital sign capture and measurement device (AMD-8221, also known as the Welch Allyn Spot Vital
Signs LXi)
Additional network connections with encryption, separate from those used to transmit the data from
medical devices, provide video conferencing capabilities between an Attendant and a Provider endpoint.
The Cisco HealthPresence Connect software transmits data from a Cisco HealthPresence Attendant
Appliance to a Cisco HealthPresence Provider Appliance, according to the intended uses of the third
party medical devices.
Note The Cisco HealthPresence-Connect software is not intended to perform real-time, active, or online
patient monitoring, and does not transmit or display any real-time data that is intended to alert a
physician of alarms or other conditions that require a physician's immediate action or response.
The users infrastructure must meet the basic minimum specified requirements for Cisco HealthPresence
to perform as intended. This includes, but is not limited to:
adequate bandwidth
appropriate latency, jitter and error rate
appropriate video call control and routing equipment
appropriate capacity routing and switching equipment
proper software levels
correct room design
adequate physical security
adequate network security
The Cisco HealthPresence solution is a network platform that combines high-definition video, advanced
audio, and patient medical data to create a live, face-to-face visit experience over the network for
clinicians and patients, even though they might be miles apart. The visit is enhanced by the availability
of physical and diagnostic information (such as vital signs) generated from a variety of medical devices
integrated with Cisco HealthPresence.
The Cisco HealthPresence solution provides effective health services from health care professionals to
multiple patient sites, optimizing the capacity and the reach of regional, health care organizations. It
enables delivery of health services to a variety of settings such as community centers, office buildings,
hotels, and educational campuses.
The Cisco HealthPresence solution integrates specialized Cisco HealthPresence software, video
endpoints and several networking elements to provide a seamless, easy-to-use solution. Specialized
software enables health professionals to start telehealth appointments and share medical data with a
single click.
1-3
Chapter 1 Overview
New Features in Cisco HealthPresence V2.0
Cisco HealthPresence V2.0 provides many new features and capabilities, providing enhancements in
usability, scalability, availability and serviceability.
Simplified Workflow and Ease of Use for Providers and Attendants
A number of features enhance the usability and workflow for Providers and Attendants. These include:
An appointment queuing model that allows Providers to select from a list of ready appointments and
allows Attendants to select from a drop down menu of Providers. This model:
Enables Attendants to quickly find the best medical Provider to address the patients needs
(based on specialty and availability), as shown in Figure 1-1.
Figure 1-1 List of Providers
Allows Providers to maximize their consultation time by accepting appointments in remote sites
with a simple click of a button. These can be regularly scheduled telehealth appointments or
appointments they assist with in spare time (for example, if they have a cancellation.) They can
triage the list of waiting appointments, as shown in Figure 1-2, and select an appointment based
on the reason for visit or time in queue.
Figure 1-2 List of Ready Appointments
1-4
Chapter 1 Overview
An enhanced user interface that simplifies collaboration between Providers and Attendants and
enables the Attendant to collect and share more detailed appointment data (such as reason for visit,
allergies and medications) before the video conference component starts.
A pause/print capability that captures (still) images from any of the supported scopes or the exam
camera, as well as all other appointment data.
A chat window that provides another means of communication between appointment or conference
attendees.
A conferencing capability that allows numerous parties to join in educational video conferences and
allows one location to stream video to two other locations as part of a conference. This can be used
for educational purposes, enabling remote viewing of a medical procedure using the exam camera
(as shown in Figure 1-3) or a medical ailment using one of the scopes (for example, sharing images
of a lesions using the dermascope).
Figure 1-3 Educational Use Case for Conferencing Capability
The ability for a single username to be associated with multiple roles: Provider, Attendant,
Participant, Presenter and Site Administrator.
Support for an ePen that can be used to write prescriptions in one location and print them in another.
(These are not electronic prescriptions.)
The next two capabilities also simplify the workflow for Attendants and Providers, and as well allow
enterprises to leverage their existing resources.
An interface to integration engines that facilitates integration of Electronic Medical Records (EMR).
This interface, coupled with the integration engines and any required back end work, enables
appointment data gathered during Cisco HealthPresence appointments to be stored in existing
medical records data bases with a simple click of a button.
Light-weight Directory Access Protocol (LDAP) support that allows medical facilities to leverage
their existing directory services to authenticate users of the Cisco HealthPresence system. This
simplifies password maintenance for the end user as well as site administrator.
1-5
Chapter 1 Overview
Business to Business (B2B) Capability
The Business-to-Business (B2B) feature enables different medical business entities to collaborate with
each other, either for B2B conferences or B2B medical consultations
2
, with a simple click of a button.
This collaboration provides several benefits:
It allows enterprises to offer more complete medical services while retaining only the most
commonly required experts on their staff.
It facilitates medical collaboration across research facilities, as conferences no longer require travel.
If facilitates offering specialist consultations during a patients regular general practitioner
appointment. The patient has a single appointment and no travel or waiting. In addition, having the
primary care physician and specialist participate in the same patient appointment can improve the
patient care.
The specialist learns first hand the medical care the patient is currently getting.
The general practitioner hears, first hand, the required follow-on care.
Infrastructure Enhancements
Multi-tenancy, that allows multiple instances of Cisco HealthPresence to reside in the same physical
server, providing a cost-effective solution for hosting services.
Higher availability, with support for a redundant server and an external Network File System (NFS)
database, enabling one server to automatically take over for another after a failure.
A scalable solution that supports:
up to 120 Provider or Attendant stations managed by a single Cisco HealthPresence Connect
Server
up to 60 endpoints concurrently in appointments or conferences
sharing of streaming medical content among 3 conference or appointment participants (one
sending and two receiving)
Enhanced Security with the capability to easily configure the security policy for the system.
Versatility and Cost Effectiveness
Support for a variety of video endpoints to address both the high-end immersive requirements, and
lower-cost desktop or personal video requirements.
Support for additional medical devices, to address needs in locales where those devices are
prevalent.
Support for a variety of data center components to support video call management and switching,
facilitating implementation in establishments with an install base of those components, as well as
providing a lower-cost entry point.
Support for interoperability between video endpoints in both point-to-point or multi-point
configurations.
Support for the Cisco TelePresence System Clinical Presence mobile cart, which enables the
solution to be easily transported to non-ambulatory patients.
2. B2B appointments or conferences are always multi-point.
1-6
Chapter 1 Overview
Smaller, More Secure Form Factor
The Cisco HealthPresence Attendant Appliance replaces both the medical device aggregator and the PC
required by Cisco HealthPresence V1.0, providing a small, secure platform that takes up less space,
generates less heat, and simplifies maintenance. Both the Cisco HealthPresence Attendant Appliance
and the Cisco HealthPresence Provider Appliance are streamlined and hardened to contain only the
required software and services.
Simplified Installation and Support
A streamlined software installation process (both in the Data Center and at the endpoints.)
An enhanced graphical user interface for configuring and servicing Cisco HealthPresence.
Cisco HealthPresence Architecture
Figure 1-4 illustrates an overview of the components in a Cisco HealthPresence solution.
Figure 1-4 Cisco HealthPresence Solution Architecture
1-7
Chapter 1 Overview
Cisco HealthPresence Components
In addition to the video components described earlier, the Cisco HealthPresence Solution includes data
center software, Cisco HealthPresence endpoint software (running on a specifically configured PC), and
medical devices. These components are described in the next few sections.
Cisco HealthPresence Software Components
The Cisco HealthPresence solution combines several different software and hardware components,
including, but not limited to, the following:
Cisco HealthPresence Connect Server, the data center software that manages all of the
connectivity. It is comprised of the following internal components:
Cisco HealthPresence Application Server (CHPAS) ties together all the components of
Cisco HealthPresence. Specifically, the Cisco HealthPresence Application Server:
- maintains the master information about resources
- manages conferences, sessions and appointments
- interfaces with CHP Connect Endpoint software, CHP Admin, CHP Portal, and Unified
Communications (UC) servers
interfaces with the EMR integration engine (either IBM Message Broker or Mirth)
- manages the flow of medical devices data through the network
Cisco HealthPresence Portal Server maintains the portal login sessions, provides the UI to
the providers and attendants and interfaces to the CHPAS to validate sessions.
Cisco HealthPresence Administration - is the management server used by the installation
team to configure, administer and manage the CHPAS and the CHPPS.
Cisco HealthPresence B2B Server which manages conferences, sessions and appointments
between endpoints managed by different Cisco HealthPresence Application Servers.
Cisco HealthPresence Attendant Appliance - a platform that resides at an Attendant Station and
includes the following components:
Cisco HealthPresence Connect Client software
AMD device aggregation software
Cisco HealthPresence Provider Appliance - a platform that resides at a Provider Station and
includes the Cisco HealthPresence Connect Client software.
Video Conferencing Support
Cisco HealthPresence supports a variety of video endpoints, call control and management systems and
multipoint bridges to address requirements ranging from low-cost desktop to high-end and immersive
and to enable a rapid deployment (in environments that have an install base of video equipment).
Video Endpoints
Cisco HealthPresence supports a number of video endpoints, giving enterprises a choice in video quality,
size/form factors, bandwidth required and cost. These video endpoints are illustrated in Figure 1-5.
1-8
Chapter 1 Overview
Figure 1-5 Video Endpoints
3
These video endpoints are described in detail in Chapter 3, Video Endpoint Considerations.
Call Control
Cisco HealthPresence solution supports both the Cisco Unified Communication Manager (CUCM) and
Cisco TelePresence Video Communications Manager (VCS). In conjunction with the appropriate
Multi-point Control Unit (MCU), the solution can support interoperability between video endpoints
managed by CUCM and video endpoints managed by VCS. For more detail on Call Control options and
interoperability, see Chapter 3, Video Endpoint Considerations.
Multi-point Bridges
In addition, the Cisco HealthPresence Solution supports the following multipoint bridges:
Cisco TelePresence Multipoint Switch (CTMS) Solutions using Cisco TelePresence-only
endpoints can use the CTMS.
Cisco Unified Videoconferencing (CUVC) Multipoint Control Unit (MCU) For solutions using
both the CTS-500 and other video endpoints, use the CUVC MCU to support video endpoints other than
CTS-500 and to provide interoperability.
3. The Cisco TelePresence System Edge 95 MXP is supported at provider endpoints only. The Cisco Unified
Communications 7985G IP Phone is now EOL.
For Current Install Base
Cisco 7985 Video Phone
C40/C20
CTS-500
Cisco TelePresence System
Edge 95 MXP
Cisco Unified Video
Advantage
EX60/ EX90
1-9
Chapter 1 Overview
4501 MCU solutions using only non-CTS-500 video endpoints can use the 4501 MCU multipoint
bridge.
For more detail on video endpoint interoperability, see Chapter 3, Video Endpoint Considerations.
Cisco HealthPresence-Supported Medical Devices
Cisco supports various integrated medical devices from 3rd-party vendors, including AMD
Telemedicine and Welch Allyn (as sold by AMD)
4
. The AMD and Welch Allyn Telemedicine devices,
shown in Figure 1-6, include:
AMD-2500 General Exam Camera
AMD -400 Image and Illumination System and its associated scopes:
AMD-2015 ENT Scope
AMD-2020 Direct Ophthalmoscope
AMD-2030 Dermascope
AMD-3700 Telephonic Stethoscope
Welch Allyn Spot Vital Signs LXi (also known as the AMD-8221 vital signs monitor)
Figure 1-6 AMD and Welch Allyn Medical Devices
Cisco HealthPresence also supports the Hi-Tech E-Pen (not a medical device) to enable a prescription,
hand written at the provider end, to be displayed and printed at the attendant end. The Hi-Tech E-Pen is
shown in Figure 1-7.
Figure 1-7 Hi-Techs E-Pen
4. Neurosynaptics devices, which are also supported by Cisco HealthPresence, are covered in an addendum to this
manual, as they are not supported in the United States.
Otoscope
Exam
Camera
Head
Phones
Telephonic
Stethoscope
Vital Signs
Monitor
1-10
Chapter 1 Overview
Furniture Options
Cisco offers two furniture options for the medical equipment, video conferencing system and Cisco
HealthPresence Connect Appliance:
Cisco HealthPresence Patient Pod
Cisco TelePresence System Clinical Presence
The Cisco HealthPresence Pod is designed to maximize work space while minimizing the footprint of
the furniture. The furniture has compartments tailored for the Cisco HealthPresence medical equipment,
computer, monitor/keyboard, device aggregator and cabling. The Cisco HealthPresence Pod enables you
to keep the work space clear yet provides convenient access to all necessary equipment. Cabling from
medical devices drops back into troughs specifically designed to maximize portability of the medical
devices, avoid tangles, and keep the work space clean. The Cisco HealthPresence Pod is shown in
Figure 1-8. The Cisco HealthPresence Patient Pod can work any of the video endpoints, but it will look
the best with a video endpoint that has a 32-inch or 37-inch display. The Cisco TelePresence System 500
(CTS 500) comes with a 37-in display and the Cisco TelePresence Codecs C20/C40 work with a 32 inch
display.
Figure 1-8 Cisco HealthPresence Patient Pod
Cisco HealthPresence Clinical Presence Cart
The Cisco HealthPresence Clinical Presence Cart enables the solution to travel to patients. Utilizing the
Cisco TelePresence System Codec C40, the Cart provides both video conferencing and Cisco
HealthPresence screens and medical equipment in a single mobile device. This is especially useful in
environments where the patient cannot easily travel to a Cisco HealthPresence Attendant Station, such
as a neonatal ICU or burn care centers.
The Cisco TelePresence System Clinical Presence is illustrated in Figure 1-9.
1-11
Chapter 1 Overview
Figure 1-9 Cisco TelePresence Systems Clinical Presence
Data Center Requirements
Cisco HealthPresence Connect Server runs on the following platforms:
Cisco UCS C200 M2 Server
A partition of the Cisco UCS C250 M2 Server
5
Cisco MCS 7845-I3 Server (Enterprise license only)
Additional components required for Multi-tenancy (supported only on a UCS C250 Server):
VMware vSphere Hypervisor (ESXi) 4.1. This runs on a UCS C250 Server.
Vsphere Client 4.1. This runs on a Windows platform.
Additional components required if implementing the high availability design option
6
:
All the software components required for Multi-tenancy, plus:
NetApp FAS2020 Network File System
vCenter Server 4.1. This runs on a 64 bit Windows platform.
5. This server is required if multi-tenancy or the hosting option is selected.
6. The high availability design option is not supported on the MCS platform but is supported on either UCS
platform.
1-12
Chapter 1 Overview
Key Considerations
For Use with Specific Software and Hardware
Cisco HealthPresence customers run the Cisco HealthPresence Connect V2.0 software on the Cisco
HealthPresence Provider or Attendant Appliance. The Cisco HealthPresence Attendant Appliance
enables an Attendant to participate in appointments with Providers using the Cisco HealthPresence
Provider Appliance. The Cisco HealthPresence Connect software aggregates video, audio and vitals
from attached medical devices.
Note Neither the Cisco HealthPresence Provider Appliance or the Cisco HealthPresence Attendant Appliance
can be changed in any way, as this can impact the performance of the solution. No software packages
may be added and existing software packages must not be modified (either by configuration changes or
service level changes, except for required service upgrades to Windows and anti-virus software.)
Key Considerations
When designing a HealthPresence solution, consider the following:
Deployment Models and Feature Sets: There are several options for how you deploy your solution
(both in the data center and in the network). As well, there are several feature sets to choose from.
Video Endpoints and Unified Communications (UC) Architecture: If you have an install base of
video endpoints and those endpoints meet the specific requirements of the Cisco HealthPresence
solution, you may want to leverage those endpoints in your design. Alternatively, if purchasing new
video endpoints, you have a number to select from. In either case, you need to determine how you will
configure these devices to support video conferencing, interoperability and if applicable, what
multi-point switches you will use.
Quality of Service (QoS) and Bandwidth: QoS provisions are required to help assure that critical data
gets priority and that real-time video
7
is handled without degradation of the images.
In addition, while a well-designed QoS strategy can minimize bandwidth requirements, a minimum
amount of bandwidth is required for each of the three site types:
data center
Attendant endpoints
Provider endpoints
Your choice of video endpoints may influence how much bandwidth you need to provision. In addition,
having point to point or multipoint conferences can also impact bandwidth.
Security: The solution has a number of features to enhance security. In addition, it offers the capability
for enterprises to define a security policy for user authentication. As part of that security policy, you need
to determine if you want an existing LDAP server to authenticate end users or if you want that
authentication done by Cisco HealthPresence.
In addition, if you are using EMR to securely store electronic medical data, you need to decide if you
want to take advantage of the integration engine interface provided in the Cisco HealthPresence Connect
Server. You can use this interface to connect to either the IBM Message Broker or Mirth. These
integration engines, when properly configured, enable to Cisco HealthPresence to access your existing
EMR system.
7. Real-time, in this instance, refers to the traffic classification of Cisco TelePresence. The Cisco
HealthPresence-Connect software is not intended to perform real-time, active, or online patient monitoring,
and does not transmit or display any real-time data that is intended to alert a physician of alarms or other
conditions that require a physician's immediate action or response.
1-13
Chapter 1 Overview
Key Considerations
Room Design: For an optimal experience using the Cisco HealthPresence solution and in particular, the
Cisco TelePresence component of the solution, several factors need to be considered, including room
size, location, lighting, colors, cooling and windows. Requirements may vary dependent on the video
endpoints selected.
Cisco Services: There are several options for how the solution can be serviced. This decision needs to
be made up front as it may affect the network design.
Each of these topics is covered in this document.
Network and QoS design are touched upon briefly in this document. For more information on network
and QoS design, refer to one of the following:
Medianet Campus QoS Design 4.0
Enterprise Medianet Quality of Service Design 4.0 - Overview
Enterprise QoS Solution Reference Network Design Guide
1-14
Chapter 1 Overview
Key Considerations
C H A P T E R
3-1
3
Video Endpoint Considerations
You selection of video endpoints must take a number of other factors into consideration. These include:
Unified Communication Models
Multipoint Bridges
Furniture
Bandwidth
This chapter touches on each of these topics and describes where to find additional information.
Video Endpoints Supported
Cisco TelePresence System 500 (CTS 500) consists of an integrated display, camera,
microphone, speakers, one Cisco Unified 7975G IP phone, and the Cisco TelePresence codec. The
CTS-500 supports video at 30 frames per second (fps) and 720p or 1080p resolution. The Cisco
TelePresence codec is the engine that drives the entire CTS-500 solution. All displays, cameras,
microphones, and speakers connect to the codec and it communicates with the network and handles
all audio and video processing.
Cisco TelePresence Edge 95 MXP includes a Tandberg PrecisionHD camera, an integrated
codec, a microphone and cables. A separate video display is required. This system is supported at
the Provider endpoint only.
Cisco TelePresence Codec C20/C40 The C-series codecs must be used in conjunction with the
LCD 100L Pro 32N monitor. The C40 codec is the video endpoint used in the Cisco TelePresence
System Clinical Presence mobile system.
Cisco TelePresence System EX60/EX90 The Cisco TelePresence System EX Series are personal
video conferencing endpoints designed for an office. The EX series are fully integrated units with a
codec, display, camera, microphone and loudspeakers.
Cisco Unified VideoAdvantage This solution comprises Unified Video Advantage software and
Cisco VT Camera III, a high-definition two megapixel video telephony USB camera with a
high-quality fixed-focus glass lens for improved performance and better image quality. The video
codec and bandwidth selection in Cisco Unified Video Advantage is completely controlled by Cisco
Unified Communications Manager. At the provider end, Cisco Unified Video Advantage enables
your Cisco HealthPresence Appliance with an attached video display to provide both video
conferencing and access to the Cisco HealthPresence appointment screens.
3-2
Chapter 3 Video Endpoint Considerations
Cisco Unified IP Phone 7985G a personal desktop video phone for the Cisco Unified
Communications solution. The phone includes a camera, LCD screen, speaker, keypad, an
integrated codec and a handset. While this device is no longer available for purchase, it is supported
by Cisco HealthPresence to address the large install base.
To support a wide variety of video endpoints and to enable interoperability between them, Cisco
HealthPresence supports the following Unified Communication models:
CUCM only mode
VCS only mode
CUCM and VCS mixed mode
The architecture diagram shown in Figure 3-1 lists the preferred registration mode for the video
endpoints supported by the Cisco HealthPresence Solution.
Figure 3-1 Preferred Endpoint Registration Mode
To understand how to enable calls between endpoints registered on the Cisco VCS Control to endpoints
registered on CUCM, see the Cisco Unified Communications Manager v6.1, 7 and 8 Cisco TelePresence
Deployment Guide
1
.
Multipoint Bridge Options
As described in Chapter 1, the Cisco HealthPresence Solution supports three bridge types:
CTMS
CUVA /60
1. http://www.cisco.com/en/US/docs/telepresence/infrastructure/vcs/config_guide/Cisco_VCS_Cisco_Unified_
Communications_Manager_Deployment_Guide_CUCM_6-1_7_8_and_X5-1.pdf
3-3
CUVC
4501 MCU
The correct bridge type for your enterprise depends on your selection of signaling mode and the video
endpoints that you use. Table 3-1 illustrates which bridges are supported in which configurations.
Table 3-1 Multipoint Bridge Compatibility
Note If the video endpoints do not support the same type of video format, then the appointment has to be
multipoint to enable interoperability. If the same video format is supported by both endpoints,
interoperability is supported in a point-to-point configuration.
Figure 3-2 illustrates the general architecture of the Cisco HealthPresence solution in an environment
that has both Cisco TelePresence System 500 video conferencing and other supported video
conferencing systems. Figure 3-3 illustrates the general architecture of the Cisco HealthPresence
solution in an environment that has only traditional Tandberg video conferencing.
Signaling Model Endpoints Required Bridge(s)
CUCM Only CTS-500 only CTMS
CUCM Only CTS-500 and CUVA CTMS and CUVC
VCS only EX series, C series, Edge 95 MXP 4501 MCU
CUCM and VCS CTS-500, EX series, C series, Edge 95 MXP,
CUVA
CTMS and CUVC
3-4
Figure 3-2 Cisco HealthPresence Solution Architecture
Figure 3-3 Cisco HealthPresence Solution High Level Architecture with VCS
Table 3-2 For More Information on Multipoint Bridges
CHPConnect Server
HighEndEndpoint(Cisco
TelePresenceSystem500)
LowBWDesktop(CiscoUnified
VideoApplication)
CUCM
DataCenter
CTMS
CUVC LDAP
CHP
Attendant
Appliance
CTS500
CHPProvider
Appliance/CUVA
CHPAdmin
CHP
Portal
CHPAS
CHPConnect Server
DataCenter
CHPAtt/Prov
Applicance
CHPAtt/Prov
Applicance
CHPAtt/Prov
Applicance
CHPAdmin
CHP
Portal
CHPAS
C40 EX90 C20
HighEndEndpoint(EX90) MidEndEndpoint(C40) Low/MidEndEndpoint(C20)
Codian VCS
LDAP
3-5
Other Considerations
Video Endpoints and Furniture Choices
Cisco HealthPresence supports several options for video endpoints, as described in Video Endpoints,
page 1-7. Any of these video endpoints are appropriate for the Provider Station. For the Attendant
Station, it depends on the furniture option selected.
For more information, see Furniture Options, page 1-10.
Video Endpoints and Bandwidth Requirements
The bandwidth requirements vary depending on the video endpoint and configuration options selected.
Refer to Chapter 4, Cisco HealthPresence Bandwidth Requirements and Quality of Service
Recommendations to understand the bandwidth options for each endpoint.
Multi-Point Switch Data Sheet
CTMS http://www.cisco.com/en/US/prod/collateral/ps7060/ps8329/ps8331/ps731
5/product_data_sheet0900aecd805faa74.pdf
CUVC 5110 MCU http://www.cisco.com/en/US/prod/collateral/video/ps7190/ps10463/data_s
heet_c78-565209.pdf
MCU 4501 http://www.tandberg.com/video-conferencing-multipoint-control/tandberg-
codian-mcu4501.jsp
3-6
C H A P T E R
4-1
4
Cisco HealthPresence Bandwidth Requirements
and Quality of Service Recommendations
This chapter discusses the minimum recommended bandwidth required for the Cisco HealthPresence
solution and the recommended QoS settings to ensure that the Cisco HealthPresence solution works as
designed and that existing network traffic is not impacted by the addition of Cisco HealthPresence
traffic.
For more information on QoS, refer to one of the following:
Medianet Campus QoS Design 4.0
Enterprise Medianet Quality of Service Design 4.0 - Overview
Enterprise QoS Solution Reference Network Design Guide
Bandwidth Requirements for Cisco HealthPresence Endpoints
The bandwidth required for a Cisco HealthPresence endpoint is the sum of the bandwidth required for
the medical device streaming and bandwidth required for video conferencing. Bandwidth requirements
vary depending on the following factors:
the number of Provider endpoints in a single appointment (each Provider receives streaming
multimedia from the Attendant endpoint.)
the quality selected for the video endpoint.
The Cisco TelePresence System 500 offers two resolution settings (720p or 1080p) and four
quality settings (lite, good, better or best). Other video endpoints also have multiple resolution
settings.
The Cisco TelePresence System EX60/EX90/Edge 95 MXP and the Cisco TelePresence
C20/C40 offer high, medium, and normal settings at 30fps or 60fps.
Note The recommended minimum bandwidth for any Cisco HealthPresence endpoint is 512kbps, but more
may be required depending on the medical devices used and the video endpoints deployed. See Table 4-2
and Table 4-3 for more details.
4-2
Chapter 4 Cisco HealthPresence Bandwidth Requirements and Quality of Service Recommendations
Bandwidth Required for Streaming Video and Audio from AMD Medical
Devices
Streaming audio and video is transmitted directly from an Attendant endpoint to a Provider endpoint in
all cases (regardless if multi-point or point-to-point is configured). If an Attendant will have two
Providers in a single appointment and plans to stream video or audio to both, then the Attendant endpoint
requires twice as much bandwidth for streaming.
Table 4-1 AMD Telemedicine Medical Device Bandwidth Requirements in kbps
1
Video Endpoint Bandwidth
The bandwidth requirements can vary based on a number of parameters: video endpoints, resolution,
frames per second (fps), and for certain endpoints, the optimal definition profile. The bandwidth
required at the per video endpoint is:
Cisco TelePresence System 500: between 1164 kbps and 4628 kbps for transmitting and between
1292 kbps and 4756 kbps for receiving.
Cisco TelePresence System EX60/EX90/Edge and the Cisco TelePresence C20/C40: between
512kbps and 2560kbps.
Cisco TelePresence System 500 Bandwidth Requirements
The Cisco TelePresence System 500 offers seven different options that affect bandwidth requirements
as illustrated in Table 4-4.
Table 4-2 Cisco TelePresence System 500 Bandwidth in kbps
2
1. These values include the encapsulation overhead.
Content BW in kbps
Audio Streaming 128
Video Streaming 800
Vitals 50
Medical Device Total 978
2. Add 20% for encapsulation overhead.
BW in
kbps 1080p Best 1080p Better 1080p Good 720p Best 720p Better 720p Good 720p Lite
Transmit 4628 4128 3628 2878 2128 1628 1164
Receive 4756 4256 3756 3006 2256 1756 1292
4-3
For example, assume an Attendant endpoint has a Cisco TelePresence System 500 and has been
configured for 720p Best. Then Cisco TelePresence requires 3006 kbps. Allowing 20% for overhead,
figure 3607 kbps for Cisco TelePresence. The Cisco HealthPresence medical device data/content
requires 2650 kbps, including overhead. If the Attendant endpoint will connect to two Provider
endpoints concurrently, bandwidth required for the Attendant endpoint is 3607 + (2 * 2650) or 8907
kbps. (A Provider endpoint with a Cisco TelePresence System 500 only requires the 6257 kbps, because
it will only receive only one video and one audio stream.)
Cisco TelePresence System EX60/EX90/Edge 95 and Cisco TelePresence C20/C40 Bandwidth
Requirements
For the Cisco TelePresence System EX60/EX90/Edge 95 and Cisco TelePresence C20/C40, the minimum
bandwidth required depends on the optimal definition profile (normal, medium or high), the resolution (from
288p to 1080) and the frames per second (fps). The Optimal definition profiles can be used when light
conditions are optimal in order to increase frame rate and resolution for lower bandwidths. In Cisco
TelePresence System Codec software, it is possible to increase the video resolution for situations where light
conditions are especially good. These settings are found under the OptimalDefinition Profile settings menu.
Refer to the operating manual for your endpoint.
The high setting should be used in dedicated rooms with optimal lighting conditions. Medium is for
good, stable light conditions. Normal is the default and is recommended in most cases. Test every room
when selecting either Medium or High mode. In rooms with daylight, the light conditions will vary and
testing should been carried out at nighttime.
Table 4-3 Cisco TelePresence System EX60/EX90/Edge95 MXP and Cisco TelePresence C20/C40 Minimum
Bandwidth Requirements in kbps
3
* Recommended. See note below.
Note For the Cisco HealthPresence solution, Cisco recommends a minimum Committed Information Rate
(CIR) of 512kbps, regardless of the capabilities or specifications of the video endpoint.
3. Add 20% for encapsulation overhead.
30fps 1080p 720p 576p 448p
Normal 2560 1152 768 512
Medium 1929 768 512 512*
High 1472 768 512 512*
60fps
Normal 2240 1472 1152
Medium 1472 1152 768
High 1152 768 512
4-4
Bandwidth Requirements for a Cisco HealthPresence Data Center
Bandwidth Requirements for a Cisco HealthPresence Data
Center
The bandwidth required for a Cisco HealthPresence data center depends on whether point to point or
multipoint is configured. The only significant traffic that flows through the data center (or more
accurately, through the multipoint switch) is the video conferencing traffic in a multi-point
configuration. Therefore, to estimate the bandwidth required at a data center, determine the maximum
number of concurrent endpoints that will be in a multi-point appointment at any point in time, and add
the bandwidth required for each endpoint using the values specified in either Table 4-2 or Table 4-3, and
then add 20% for encapsulation overhead.
Consider this example. Referring to Table 4-2, assume there are five Cisco TelePresence System 500
endpoints each using the best resolution for 720p. Then Cisco TelePresence requires enough bandwidth
at the data center to transmit five video streams of 2878kbps + 20% overhead, and to receive five video
streams at a bandwidth of 3006kbps + 20%. This equates to a Tx BW of 17,268kbps and a Rx BW of
18,036kbps, or approximately 19 Mbps for each.
All medical device data and streaming content is peer-to-peer so streaming medical data does not add
any bandwidth requirements to the data center, unless the data center site is also the site of one or more
Cisco HealthPresence endpoints.
Quality of Service
A major benefit of the Ciscos HealthPresence solution is that real-time
4
, high-definition video and
audio (Cisco TelePresence) and streaming video and audio (from medical devices) can be transported
over a converged IP network. The key enabling technology to accomplish this convergence is Quality of
Service (QoS).
QoS technologies refer to the set of tools and techniques (such as queuing and prioritization) to manage
network resources so that varying network traffic requirements are addressed. In particular, for real-time
interactive traffic, such as Cisco TelePresence, latency, jitter, and loss are minimized. QoS technologies
allow different types of traffic to intelligently contend for network resources. For example, voice and
real-time video may be granted strict priority service, while some critical data applications may receive
(non-priority) preferential services and some undesired applications may be assigned deferential levels
of service. Therefore, QoS is a critical, intrinsic element for the successful network convergence of
voice, video, and data.
The Cisco HealthPresence solution incorporates a number of components. Several of these components
generate a different type of traffic and hence have different QoS requirements. The traffic types include:
Cisco Telepresence System 500: To create an optimal face-to-face experience over the network,
Cisco TelePresence requires very strict service levels when it comes to latency, jitter, and loss. In a
multi-point implementation, this traffic always flows through a Cisco TelePresence Multipoint
Switch (CTMS) in the data center. In a point-to-point environment, this traffic goes direction from
one endpoint to another.
Other Video Conferencing Systems: While less bandwidth intension, other supported video
conferencing endpoints still require adequate bandwidth and prioritization to assure that the end user
experience is optimal.
4-5
QoS Best Design Practices for Cisco HealthPresence
Multimedia streaming traffic (Cisco HealthPresence medical devices stream video and audio from
the Cisco HealthPresence Attendant Appliance to the Cisco HealthPresence Provider Appliance).
This traffic always flows directly from the Attendant Appliance to the Provider Appliance and does
not go through the data center.
HTTPS/HTTP data (patient data, vitals data, and application data to begin and end appointments and
manage the flow of the Cisco HealthPresence telemedicine appointment). This traffic is typically
encrypted and always goes to the data center. It is not significant from a bandwidth perspective. For
simplicity, this data can be marked and queued with the multimedia streaming traffic or left
unmarked and sent in the best effort queue.
When designing a network to support Cisco HealthPresence, QoS best design practices should be
employed wherever possible. These best practices include the following:
Classification and marking policies should be implemented in Cisco Catalyst hardware as close to
the source of the traffic as possible (e.g., on the access edge switch to which the Cisco
HealthPresence System is attached).
Use Differentiated Services Code Point (DSCP) whenever possible. DSCP provides more
granularity than IP Precedence.
Always deploy QoS in hardware, rather than software, whenever a choice exists. QoS policies, like
classification, marking/remarking, and/or policing can all be performed at line rates with zero
Central Processing Unit (CPU) impact in Catalyst switches. Cisco IOS routers, on the other hand,
perform QoS operations in software, resulting in a marginal CPU impact, the degree of which
depends on the platform, the policies, the link speeds, and the traffic flows involved.
Follow industry standards whenever possible, as this extends the effectiveness of your QoS policies
beyond your direct administrative control. For example, if you mark a real-time application, such as
VoIP, to the industry standard recommendation as defined in RFC 3246 (An Expedited Forwarding
Per-Hop Behavior), it receives high priority servicing at every node within your enterprise network.
When you hand off this traffic to a service Provider, they provision traffic marked Expedited
Forwarding (EF - or DSCP 46) in a strict priority manner. Therefore, even though you do not have
direct administrative control of the QoS policies within the service Providers cloud, you have
extended the influence of your QoS design to include your service Providers cloud simply by
following the industry standard recommendations. The relevant standards are listed below in
chronological order:
Between Ciscos QoS Baseline and RFC 4594 is the RFC 4594 recommendation to mark Call
Signaling as CS5. Cisco plans to continue marking Call Signaling as CS3 until future business
requirements arise that necessitate another marking migration. Therefore, for the remainder of
this document, RFC 4594 marking values are used throughout, with the one exception of
swapping Call-Signaling marking (to CS3) and Broadcast Video (to CS5). These marking
values are summarized in Table 4-4.
4-6
Table 4-4 Cisco Marking Recommendations
Best Practices for Converged Networks
In addition to the above best practices, the following best practices apply to converged networks:
Limit the amount of real-time voice and video traffic to 33% of the link capacity or else data may
be starved out resulting in very slow and erratic performance of data applications.
Reserve at least 25% of the link bandwidth for the default Best Effort data class.
Utilize a 1% Scavenger or Low-Priority class to ensure that unruly applications do not dominate
your default Best Effort data class.
Use Weighted Random Early Detection (WRED) on all TCP flows, where ever possible, preferably
DSCP-based WRED.
Application L3 Classification
PHB
L3 Classification
DSCP
Application
Examples
Network Control / Routing CS6 48 EIGRP, OSPF,
HSRP, IKE
VoIP Telephony / Voice EF 46 Cisco IP Phone
Broadcast Video (RFC 4594
only)
CS3 by RFC 4594,
CS5 by Cisco
24 by RFC4594,
40 by Cisco
Cisco IPVS,
Enterprise TV
Real-time Interactive CS4 32 Cisco TelePresence
System 500, Cisco
HealthPresence
Medical Device
traffic
Multimedia Conferencing AF4 34 Cisco CUPC,
WebEx, Interactive
Video
Multimedia Streaming AF3 or CS4 26 Cisco DMS, IP/TV,
Call Signaling (same name
used by both)
CS5 by RFC 4594,
CS3 by Cisco
40 by RFC4594,
24 by Cisco
SCCP, SIP, H323
Low-Latency Data /
Transactional Data
AF21 18 ERP Apps, CRM
Apps
Operations/Administration
/Management (OAM) /
Network Management
CS2 16 SNMP, SSH, Syslog
High-Throughput Data /
Bulk Data
AF11 10 Email, FTP,
Backups
Best Effort - same name
used by both
DF 0 Default Class
Low-Priority Data /
Scavenger
CS1 8 You Tube, Gaming,
P2P
4-7
Marking Cisco HealthPresence Traffic
The recommended marking for traffic is as follows:
Cisco TelePresence System 500: Class Selector 4 (CS4)
Interactive video from all other video endpoints: DSCP AF41
Cisco HealthPresence streaming multimedia: Class Selector 4 (CS4).
You can mark Cisco HealthPresence streaming multimedia by doing the following steps:
Step 1 Create an access list for Cisco HealthPresence traffic:
ip access-list extended CHP-ACL
permit udp [CHP_APPL_IP_ADDR] any eq 5000
! Put all traffic from the Cisco HealthPresence Appliance interface with ports 5000-5003 into
access-list CHP-ACL
Step 2 Use the following global commands to match access-group CHP-ACL to a class named CHP-CLASS
and then mark all the CHP-CLASS traffic as DSCP 32.
class-map match-all CHP-CLASS
match access-group name CHP-ACL
! maps all traffic in access-group CHP-ACL to the class named CHP-CLASS
!
policy-map MARK-CHP-DSCP
class CHP-CLASS
set dscp 32
! sets dscp to 32 for all traffic in the class named CHP-CLASS
4-8
C H A P T E R
5-1
5
Cisco HealthPresence Security
Overview
The security policy for the Cisco HealthPresence solution should be determined prior to installation. As
part of the install process, you will be asked how you want your end users to be authenticated and if you
want the end users authenticated by Cisco HealthPresence, how you want passwords, inactivity and
lockout handled. This section covers the decisions you need to make prior to installation and in addition,
discusses other security features of Cisco HealthPresence.
Note This chapter discusses the security features in the Cisco HealthPresence solution. It is the responsibility
of the enterprise to assure that any other required security measures are implemented (for example,
securing data sent to a printer or protecting passwords.)
Authentication / Access Control
Authentication Options
Cisco HealthPresence allows end users to be authenticated in one of two ways:
External LDAP server
If required, you can configure your system to support both means of authentication. The alternatives are
described below.
External LDAP-Authentication
There are a number of reasons to choose external LDAP authentication. By choosing to authenticate
using an external LDAP directory:
End users can use the same username for multiple applications.
End users change their password once and the new password is then valid across all systems that
interface to the LDAP server.
5-2
Chapter 5 Cisco HealthPresence Security
Authentication / Access Control
Administrators can remove an end user from all systems at once.
Administrators can reset a password and have it affect all systems at once.
Site wide security policy and changes are automatically reflected in Cisco HealthPresence.
Dedicated Cisco HealthPresence Authentication
You can choose to have Cisco HealthPresence authenticate end users if you do not have an external
LDAP server or if you want Cisco HealthPresence users to have a unique user name or password that
works only with Cisco HealthPresence (but note that there is no way to assure that the end user doesnt
use the same password in all cases).
Mixed Authentication
Mixed authentication offers the best of both worlds. It allows you to leverage your LDAP directory to
authenticate most Cisco HealthPresence users, but it also allows special user IDs to be created ad hoc
for training purposes or perhaps for temporary employees. It also allows you to utilize the training and
testing user names that ship with the product, regardless of how you want other users authenticated. If
you opt for mixed authentication, your site administrator can add users to be authenticated by Cisco
HealthPresence or enable users (who are authenticated using an external LDAP directory) to use Cisco
HealthPresence.
Cisco HealthPresence Security Policy
As part of the installation of Cisco HealthPresence, you need to make certain decisions about the security
policy you want to have enforced. That security policy primarily applies to Cisco Health-Presence
Authenticated Users, but has two additional parameters that apply to all users.
Security Policy Controls for Cisco HealthPresence-Authenticated User Names
Access to the Cisco HealthPresence system is controlled by passwords at both the Attendant endpoint
and the Provider endpoint. These passwords are encrypted using AES encryption before being
transmitted over the network, and encrypted using MD5 before being stored in the Cisco HealthPresence
data base.
The following security policies can be modified for end users that are authenticated by Cisco
HealthPresence (dedicated):
Force a password change on the first login.
Disable an account if the user does not log in for a certain number of days. The inactivity days can
range from 1 to 730. (This does not apply to the site administrator id.)
Have passwords expire after a certain number of days. The expiration days can range from 1 to 999.
Require strong passwords. You can specify the minimum password length and the minimum number
of character types. The length of strong passwords can be between 1 and 15 characters with a
minimum of character types ranging from 1 to 4.
Prevent password reuse. You can specify the number (1-20) of saved passwords.
5-3
Cisco HealthPresence Appliance Security
Security Policy Controls for All Cisco HealthPresence User Names
The following security policy affects all users (including externally authenticated users):
Auto-log out a user for PC inactivity (pressing enter, clicking a mouse key, etc.) during a Cisco
HealthPresence session. The log out can be specified to occur after a specified period (between 1
and 999 minutes) of inactivity, after which a warning message is displayed. You can also specify the
duration of time after the warning message and before the log out. It can be any integer between 1
and 60 minutes.
Other Authentication Security Features
To enhance security, both the end user and the Cisco HealthPresence Endpoint must be authorized to
access Cisco HealthPresence.
Enabling an Endpoint to Access Cisco HealthPresence
An Endpoint Administrator is responsible for configuring an endpoint to enable it to communicate with
Cisco HealthPresence.
Enabling Users to Access Cisco HealthPresence
A site administrator is responsible for configuring Cisco HealthPresence end users to enable them to
access the Cisco HealthPresence system. Configuration varies dependent on how those end users are
authenticated.
End users authenticated by Cisco HealthPresence must be added. The site administrator must
specify a username, password and display name. In addition, the site administrator must check a box
for each profile that this end user will require. Profiles include: Provider, Attendant, Presenter,
Participant and Siteadmin. An end user can be configured with any combination of these profiles.
Externally authenticated end users are enabled to access Cisco HealthPresence. In addition, these
end users can be configured to support any combination of the five user profiles. The display name
of externally authenticated end users is their LDAP common name.
Cisco HealthPresence Appliance Security
The Cisco HealthPresence Provider and Attendant Appliances are hardened PCs
1
with all unnecessary
software removed. When a Cisco HealthPresence user logs into a hardened Cisco HealthPresence
Appliance, the login screen appears immediately and no other services can be accessed. The
non-essential services that are removed as part of the PC hardening include:
Windows Error Reporting Service
Tablet PC Input Service
Security Center Service
Remote Registry Service
Protected Storage Service
Portable Device Enumerator Service
Windows Search Service
1. If PC Hardening is selected when the system is installed.
5-4
Transmission Security
Also as part of PC hardening, firewall settings are modified to assure that only authorized processes and
services can be accessed from the Cisco HealthPresence Appliance.
Note PC hardening is not required but is recommended to assure the security of the Cisco HealthPresence
system.
Transmission Security
HIPAA compliancy requires Electronic Protected Health Information (ePHI) be protected from
unauthorized access. That means that any time health information is transmitted with an identifier (such
as a patient's name), that information must be protected from unauthorized access. As part of the Cisco
HealthPresence Plan, Design and Implement phase, Cisco or its partners will review the customers
security requirements and take these requirements into consideration in the design. It is imperative that
the customers Security Office be involved in the design sign off. Their involvement and sign off will
help ensure that the technology design integrates with the customers policies, procedures and workflow
to allow the customer to achieve HIPAA compliance. The customer and covered entity is ultimately
responsible for HIPAA compliance.
When ePHI traverses public networks, some form of encryption must be utilized. To provide security,
HTTPS is the default for communication across all web services.
The following security measures are implemented to prevent unauthorized access for data in transit:
HTTPS channel
Auto redirect from HTTP to HTTPS
Folders on the Cisco HealthPresence Portal Server accessible with SSL encryption only
Secure Web services for registration and authentication
Patient Privacy
Cisco HealthPresence uses 128-bit encryption to protect patient information. In addition to transmission
security, patient data is protected by preventing unauthorized access to the data on the Cisco
HealthPresence PCs (both the display screens and the hard drive) at either the Provider or Attendant
sites.
All modules are protected by various username/password combinations based on the role
(Provider/Attendant) and the module and, hence, accessible only by appropriate authorized personnel.
The Cisco HealthPresence solution does not store any patient data on a permanent basis within its
domain.
The audio and video streams do not pass through the various modules in the solution. The video and
audio streams flow directly between the Cisco HealthPresence Connect Appliance at the Attendant
station and the doctor(s) UI.
The streams are not recorded at either end point. They are transmitted using RTP (UDP-based) and
encrypted using AES-128.
5-5
Network Security
After the Attendant clicks Ready and then Share to share vitals data, it is temporarily stored in
memory. Any Providers requested by the Attendant to participate in the appointment will see the
vitals data once they enter the appointment. When the Provider leaves the appointment, the vitals
data is removed from the Providers Cisco HealthPresence Appointment window. Anyone not a part
of the same appointment as the Attendant is unable to view the shared data.
When the Attendant leaves the conference, the shared vitals data is deleted. If the Attendant logs off the
without leaving the conference, the shared vitals data is deleted as well.
If a session is idle for a configurable number of minutes, the end users get a warning message. If there
is no response to the warning message in 5 minutes
2
, the conference is terminated and the data is
discarded.
Network Security
The Cisco network has inherent security features that provide additional security. These include:
VPN Security
Endpoint Encryption
CTMS Encryption
Dedicated Overlay
Firewall Access
As part of the Cisco HealthPresence Plan, Design and Implement phase, Cisco or its partners will utilize
one or more of these capabilities to implement the security requirements defined by the customer's
security officer.
Using Firewalls in Converged Networks
A firewall is a part of a computer system or network that is designed to block unauthorized access while
permitting authorized communications. It is a device or set of devices which is configured to permit or
deny computer applications based upon a set of rules and other criteria. By controlling access to Cisco
HealthPresence servers, a firewall can prevent malicious or unauthorized network connections from
being initiated to critical servers, which could impact performance or availability. By inspecting the
connections to ensure that they meet the access control policy and that the connection conforms to
expected behavior, firewalls provide a first line of defense for a secure deployment.
To enable firewalls and allow Cisco HealthPresence to function properly, you may need to know the ports
and protocols used by the Cisco HealthPresence solution. Table 5-1 shows the ports and protocols used
by various components of the Cisco HealthPresence solution. If using a video endpoint other than the
CTS-500, verify that the correct ports are opened.
Also, to efficiently manage certain tasks, you may want to provide access between Cisco HealthPresence
servers and outside resources. For example, you may want to enable Cisco support to remotely access
the Cisco HealthPresence Connect Appliance. You may need remote printing or access to LDAP
directories or Electronic Medical Records systems.
2. This is the default, but the value is configurable.
5-6
Cisco HealthPresence and Cisco TelePresence TCP and UDP ports
The Cisco HealthPresence solution uses the ports described in Table 5-1.
Table 5-1 Ports used by the Cisco HealthPresence
3
Figure x provides a representative view (for a CTS-500 and AMD medical device solution) of the
required ports and where the firewalls must be adjusted to allow required traffic to pass through.
Product Protocol Transport Ports
Attendant/Provider
Appliance
HTTP/HTTPS, SSH, SNMP UDP/TCP 22, 80, 161, 443, 2442,
2443, 2444,
50000-50003
Cisco TelePresence
System 500
SIP/RTP UDP 5060, 5061,
16384-16389
Connect Server
HTTP/HTTPS UDP/TCP 161, 443
CUCM JTAPI UDP/TCP 2748
CUVA CUVA
Cisco Audio Session Tunnel
(CAST)
UDP
TCP
5445
4224
3. You may need to enable additional ports for your specific video endpoints, for EMR, for LDAP, or for a
networked printer. This should be determined as part of the Planning phase.
5-7
Figure 5-1 Cisco HealthPresence Ports and Protocols: CTS-500 and AMD Example
5-8
C H A P T E R
6-1
6
Cisco HealthPresence Room Design and
Physical Requirements
Physical Room Design and Requirements
1
To maximize the aesthetics and usability of the Cisco HealthPresence solution, pay careful attention to
the design of the rooms that will house the Cisco HealthPresence pods. Ensure the pod sites include the
following:
Network outlets: At least two network ports are required. Ideally, these should be installed on the
wall where the Cisco HealthPresence furniture or video communications display will be placed.
Power outlets: For Attendant stations with a Cisco TelePresence System 500, at least two dedicated
power drops are required (with quad outlets preferred). Each power drop must be on a dedicated
circuit protected by separate circuit breakers. For any other video conferencing system, only one
circuit/power drop is required (with quad outlets preferred). Ideally, these should be installed on the
wall where the Cisco HealthPresence Connect Appliance and video communications display will be
placed. For specifications and standards compliance information, refer to the Cisco HealthPresense
Specifications, Warnings and Precautions document.
External phone jack - This is optional but recommended for making external calls to Cisco
HealthPresence support organizations or emergency services.
Lighting: The video conferencing experience will be best with 300400 lux of evenly dispersed,
indirect ambient light.
Noise levels: Ideally, the Cisco HealthPresence Provider or Attendant station placement should be
such that outside noise is minimal, as it could negatively impact the Cisco HealthPresence
experience.
1. This chapter assumes this is a new installation.
6-2
Chapter 6 Cisco HealthPresence Room Design and Physical Requirements
Room Dimensions and Characteristics
Room Dimensions
The recommended room size varies based on a number of parameters. Key among those are the
following:
Furniture size - The room must be sized to allow for patient and Attendant mobility while
accommodating the furniture and storage used to house the video conferencing equipment, medical
equipment and the Cisco HealthPresence Connect Appliance. The dimensions of the optional Cisco
HealthPresence Patient Pod and the mobile Clinical Presence System are included later in this
chapter.
Distance between patient/Provider and camera - Depending on video conferencing endpoint, you
need to allow at least two and a half to four feet between the video conferencing camera and the
Provider and between four to six feet between the video conferencing camera and the patient (where
a larger field of vision is typically required.) It depends on the size of the screen and whether or not
the camera has a tilt feature. Consider this when deciding on the room size and furniture placement.
Refer to the installation manual for the particular video camera to determine the optimal distance
and if required, test the distance as part of the installation.
Air flow - The room needs to be large enough to provide adequate air flow to dissipate the heat from
the video equipment and other gear in the room. (Refer to the HVAC section of this chapter).
Room Dimensions for Cisco HealthPresence Furniture Options
If you select the Cisco Health Presence Patient Pod, the recommended minimum room size is ten feet by
eleven feet. Figure 6-1 shows the dimensions of the Cisco HealthPresence Patient Pod. Table 6-1
provides the recommended room dimensions for a room that is to contain the stationary Cisco Health
Presence Patient Pod.
Since the doctor's endpoint typically has no medical equipment, the doctor's office/endpoint can be a bit
smaller. If you are using a CTS-500, the dimensions for the doctor's endpoint should be no smaller than
6 by 8 feet and the CTS-500 should be placed along the 6 foot wall.
6-3
Figure 6-1 Dimensions of the HealthPresence Patient Pod (Pictured with a Cisco TelePresence System 500)
Table 6-1 Recommended Room Dimensions
Clinical Presence System
The Clinical Presence System is a portable system that enables the Attendant station to be moved to
the patients room. It includes a Cisco TelePresence System C40 for video conferencing and another
monitor to use with the Cisco HealthPresence Connect Appliance. Attendant medical equipment stores
in the cabinet in the base.
The dimensions of the Clinical Presence System are as follows:
Width: 25 / 63.5 cm
Depth: 33 / 83.8 cm
Height:
Lift down: 67 / 170.2 cm
Lift up: 77 / 195.6 cm
While the room dimensions are not really an issue, doors must be 30 inches wide to accommodate the
system.
Width Depth Height
Minimum 10 feet (3.04m) 11 feet (3.35 m) 9 feet (2.43m)
Maximum 15 feet (4.57m) 15 feet (4.57m) 10 feet (3.04m)
6-4
Figure 6-2 Clinical Presence System
Ceiling Height
Ceiling heights should be between 8' and 10'. Adequate height is necessary to allow the ceiling fixtures
enough distance to dissipate lighting across the environment in an even manner. Lower ceilings tend to
promote greater contrast in lighting conditions and hot spots on participants shoulders.
Ceilings higher than 10' (3.05m) may need special acoustic treatment as higher ceilings usually have a
corresponding greater amount of hard surface wall space. Adding acoustic paneling to the walls can treat
this. Open air ceilings, such as found with rooms within a room" are not recommended due to possible
distractions from exterior sources of sound and privacy concerns for the patient.
Door Locations
Doors can be located anywhere within the room. However it is optimal to have them out of view from
the camera and not behind the system. If doors must be within camera view they should be located on
side walls. Doorways should also provide a sealed closure in order to block noise transferring from
exterior corridors. Gaskets and door skirts should be used along with solid or insulated doors for best
sound insulation. Shielded from distraction and insuring privacy are highly desirable characteristics to
a Cisco HealthPresence room.
Windows
Cisco recommends that a Cisco HealthPresence room have windows or glass walls that consume less
than 20% of vertical wall space. Windows and glass walls allow uncontrollable light to affect the quality
of the video and overall experience. These hard surfaces will also promote undesirable acoustical
6-5
Heating, Ventilating, and Air Conditioning (HVAC)
conditions such as audio reverberation. All windows and glass walls must be treated with materials that
have acoustical dampening and light blocking characteristics. No external window should be in view of
the camera. If it is unavoidable, window coverings should be installed to block any external lighting.
The furniture should be set up so that the covered window is not behind the participants.
Heating, Ventilating, and Air Conditioning (HVAC)
Heat dissipation from the Cisco TelePresence unit and other devices in the room will increase the
temperature in the room. Table 6-2 illustrates the power used and resulting BTUs dissipated per hour for
each of the various devices and for each person in a room with a Cisco HealthPresence Pod. (Remember
that not all devices are powered on all day long, so that actual BTUs could vary.)
These numbers assume an interior room with proper air circulation, walls painted neutral colors, and
temperatures averaging 72-76 degrees Fahrenheit. Conditions not in line with these recommendations
may require additional cooling.
2
Table 6-2 BTU Summary
Illumination
Consider the following lighting recommendations:
Avoid direct light on people or the camera lens. Direct light will create harsh contrasts and shadows.
If you have poor lighting in the room, you may need to use indirect, artificial light. Indirect light
from shaded sources or reflected light from pale walls often produces excellent results.
"Daylight" type lamps are most effective. Avoid colored lighting that might tint your image.
Don't place reflective white-boards directly behind people or where lighting may reflect and cause
glare. If they are not required, remove them altogether.
2. The operating temperature for the Cisco HealthPresense Solution is between 50 to 104 (10 to 40 C) unless
using the mobile cart, in which case the temperature range is 50 to 95 (10 to 35 C).
Entity Power BTU/Hr
Cisco TelePresence System 500 0.36kW 1230 BTU/Hr.
Cisco TelePresence System EX90 0.15kW 512 BTU/Hr.
Cisco TelePresence System EX60 0.08kW 256 BTU/Hr.
Cisco TelePresence Codec C20 0.08kW 256 BTU/Hr.
Cisco TelePresence Codec C40 0.18kW 597 BTU/Hr.
LCD 100L Pro 32N monitor (for C20/C40) 0.16kW 546 BTU/Hr.
Ceiling Lights (120 sq. ft.) 0.17kW 580 BTU/Hr.
AMD Medical devices 0.1kW 340 BTU/Hr.
Cisco HealthPresence Connect Appliance .09kW 307 BTU/Hr.
Each PC in the room 0.055kW 187 BTU/Hr.
Each person in the room 0.065kW 225 BTU/Hr.
6-6
Illumination
Depending on your environment and choice of video endpoint, you may want specific lighting to be
installed in the ceiling to fill in the shadows often seen masking participant's eyes and other facial
features.
You can optionally enhance the experience further by adding specific lighting to create a more dramatic
effect with the depth perception and architectural features.
Considering Light Angles and Direction
In a three-point lighting system, three points, or directions, of light influence what the camera sees:
The light that fills the entire environment is ambient light, or fill light. This light generally comes
from fixtures in the ceiling to blanket the room in even, well-distributed light.
The light that falls on a participant's face is participant light, or point light. This light illuminates
the face to reduce shadows around the eyes, neck, and other such surfaces that directly face the
camera. Point lighting generally does not exist in the average conference room and, therefore, is
supplied as part of the Cisco TelePresence system. It is not inherent in the other video
communication systems.
The perceived depth in an image as viewed by a camera is best when the subjects' shoulders and the
tops of their heads are gently illuminated, causing them to pop out" from the background behind
them. This is shoulder lighting, or rim lighting and is optional for a high-quality video
communications image. You can also use rim lighting to illuminate the wall behind the participants
to achieve a similar effect (depth in the perceived image).
The critical types of light for a Cisco TelePresence solution are ambient (fill) and participant (point)
lighting. Shoulder (rim) lighting is optional and left to the discretion of the customer whether to
implement it.
The Cisco HealthPresence System operates best with 300-400 lux of evenly dispersed, indirect ambient
light. Indirect fluorescent lighting fixtures often provide best results. These fixtures are most efficient
when an asymmetrical light distribution is used. This will ensure greater illumination of participants
without bleeding light onto plasmas and projection screens. Color temperature is also an important factor
as it helps to unify the environment and provide a higher quality experience. A 4000K type 5 or 8
fluorescent lamp is recommended.
Ideal Lighting Environment
Average lighting at 300-400 lux vertical plane
Lighting on horizontal plane below 700 lux
Lighting even throughout the room
Windows covered with light blocking material
Auto feature setting of Cisco TelePresence disabled
Background Recommendations
The camera will show what ever is behind the participant in a video conference. To optimize the
experience for the participants:
Provide a calming background with a neutral color, medium contrast and soft texture.
Avoid patterns on the walls.
6-7
Illumination
Avoid moving backgrounds such as curtains in a draft or people walking behind you. This may
reduce image quality and distract the attention of those on the far end.
Do not place the camera facing a doorway.
Choose a table that is light but not reflective. A light natural wood is a good choice.
Avoid unnecessary furniture or clutter in the room.
Paint Colors
The background wall (the wall visible to the other party in a video conferencing call) should be painted
a neutral color with medium contrast and soft (not glossy) texture. Avoid patterns on the wall or clutter
in the line of sight of the camera.
For best results, use a warm tone color on the back wall. Do not use dark colors or very light colors.
Because of the vast number of different color systems and paint manufacturers throughout the world, it
is not possible for Cisco to specify exact color reference indexes on a global level. Therefore, for
simplicity and optimal results, refer to the following Benjamin Moore paint colors as a reference:
Cork 2153-40
August Morning 2156-40
Classic Caramel 1118
Wilmington Tan: HC-34
Huntington Beige: HC-21
Woodstock Tan: HC-20
Fairmont Gold: 1071
For more information on room design, see the Cisco TelePresence Room Design (a chapter of Cisco
TelePresence Fundamentals) at http://www.ciscopress.com/articles/article.asp?p=1351075.
Chair Requirements
To maximize the effectiveness of the Cisco HealthPresence appointment, it is best if the patient sits in a
chair in front of the Cisco TelePresence camera. However, you may need to also offer an examination
table for patients who are not well enough to sit.
Note If the patient needs to lie down during the exam for medical reasons, the physician and patient can still
see each other, but since you might be putting the patient outside of the optimal CTS-500 camera focal
range, the patient will appear smaller in the physician's Cisco TelePresence screen. Also, patient facial
expressions and true skin color may be harder for the physician to see, and eye contact may not be
possible.
The chair used in the Attendant endpoint should have the following characteristics:
Height adjustment capabilities, so that the patients head can be raised to approximately the height
of the Cisco TelePresence camera
3
. This puts the patients face near the top of the Cisco TelePresence
screen and makes eye contact easier.
3. The required maximum seat height can vary depending on the height of the Cisco TelePresence camera.
6-8
Illumination
Wheels and mobility, so the Attendant can easily move the patient when getting video images and
concurrently checking the focus on the telemedicine appointment screen. This also enables the
Attendant to move the patient per physician instructions.
Locks on wheels, to prevent unintentional movement.
A chair back that doesnt impact the physicians ability to view the patient. The back should not be
too high or wide as it blocks the physicians view of the patients back. Best choices have a small
back pad for support.
Chair material that allows for proper sanitation between visits.
The chair used in the Provider end point should have height adjustment capabilities, so that the
physicians head can be raised to approximately the height of the Cisco TelePresence camera. (At this
height, the physician appears to make eye contact, making the Cisco TelePresence session feel more
personal.)
Note You may want arms on the chair so that the patients arm is supported when having their blood pressure
taken. In addition, shorter patients may feel more comfortable if the chair has a foot rest that raises with
the chair.
C H A P T E R
7-1
7
Cisco Services for Cisco HealthPresence
Revised: November 16, 2011, OL-23332-08
Challenge
To provide affordable health care and to address the needs of people in remote geographical areas,
medical care Providers need to virtually eliminate geographic boundaries and leverage the medical talent
in central locations. Cisco HealthPresence offers a new technology platform that creates in-person
experiences between patients and medical care Providers regardless of their locations. However, to gain
the full advantages of this solution, organizations need to make sure that Cisco HealthPresence is
properly deployed and that the critical elements of the solution are functioning optimally at all times.
Note For the latest Cisco Service descriptions, see
http://www.cisco.com/web/about/doing_business/legal/service_descriptions/index.html.
Solution
To ensure that the Cisco HealthPresence solution offers the best performance, highest security, and most
reliable operation, Cisco offers a full lifecycle of professional services from planning through
installation and optimization. Starting with the planning phase, the solution is designed to meet specific
customer requirements and at the same time optimize the network for reliability, security and
performance. Next the solution is installed, configured and tested on site. The customer is trained to use
both the HealthPresence software and the medical devices. The solution is not considered delivered until
the customer signs off on both the functionality and the training.
Once the customer accepts the solution, Cisco's suite of day two operational services ensure that issues
are addressed quickly and efficiently.
These services play an essential role in the successful deployment and ongoing operation of Cisco
HealthPresence technology by protecting the enterprises' investment and helping them achieve the full
benefits of the solution. Ultimately, Cisco Services for Cisco HealthPresence let enterprises focus on
business transformation-not the technology.
7-2
Chapter 7 Cisco Services for Cisco HealthPresence
Solution
Cisco Services for Cisco HealthPresence encompass the following service offerings:
Cisco HealthPresence Workshop
Cisco HealthPresence Plan, Design, and Implement Service (PDI)
Cisco HealthPresence Product Level Day 2 Support:
Cisco HealthPresence Custom Application Support (CAS)
Cisco HealthPresence Application and Telemetry Support (ATS)
Cisco SMARTnet
Cisco HealthPresence Solution Level Day 2 Support

Cisco HealthPresence Remote Management Services (RMS)
Partner Delivered Day 2 Support Model
Customer Managed Day 2 Support Model
Together, these offerings provide a comprehensive suite of services designed specifically for Cisco
HealthPresence solutions, based on the Cisco Lifecycle Services framework shown in Figure 7-1. The
services draw on proven methodologies to accelerate the business benefits of Cisco HealthPresence
technology, and focus on the solution 24 x 7 so that enterprise IT departments can focus on their core
business.
Figure 7-1 The Cisco Lifecycle Services Approach
Note Configuration and support are strictly provided within the labeled usage approved by the United States
Food and Drug Administration and other such regulatory jurisdictions where Cisco HealthPresence is
approved for use by licensed health care professionals.
7-3
A Business Value engagement identifies the cost savings, productivity enhancement and business
transformation opportunities enabled by the Healthcare Collaboration and video platform, which
provides a detailed quantification of the business benefits. This is a collaborative exercise between Cisco
and the customer. The solutions as well as related quantifications are developed and validated with the
customer before being finalized.
Quantify through a systematic process the savings potential and business benefits of Tele-health, as
shown in Figure 7-2.
Figure 7-2 Healthcare Service Return on Investment
Quantify the productivity and business transformation impact of Tele-health and the collaborative
video-enabled healthcare provided by the Cisco HealthPresence solution, as illustrated in
Figure 7-3.
7-4
The Cisco HealthPresence Plan, Design, and Implement Service
Figure 7-3 Evaluation of Tele-Health on Business Impact
The Cisco HealthPresence Plan, Design, and Implement Service
Cisco HealthPresence technology has a profound effect on an organizations ability to provide
high-quality medical care to remote locations. However, to provide the consistent, high-quality
experience required, the organizations network, Cisco HealthPresence endpoints, and the Cisco
HealthPresence solution itself must be optimally designed and implemented. Without careful
consideration of an enterprises specific business and technical requirements, IT and end-user
experience, and the effects of Cisco HealthPresence on the overall network, organizations might not
realize the full potential of the solution.
The Cisco HealthPresence Plan, Design, and Implement Service provides comprehensive support
throughout the planning and deployment of a Cisco HealthPresence solution, helping organizations
quickly realize the benefits of this new real-time
1
, immersive technology. The service helps enterprises
achieve their business objectives by assessing the existing network and physical environments,
developing an implementation-ready design based on the organizations unique requirements, and
working with internal IT staff throughout the implementation and testing of the solution as well as
through end-user training.
The Cisco HealthPresence Plan, Design, and Implement Service consists of the following service
components:
Project Management - When an enterprise is ready to begin the plan phase of deployment, Cisco or
a certified Cisco partner delivers a comprehensive project schedule for the implementation and
provides a single point of contact for all issues relating to the solution.
Requirements Validation - The project team performs a detailed requirements validation to assess
the customer's business and technical requirements and verify that the deployment will meet
expectations.
7-5
Cisco HealthPresence Product Level Day 2 Support
Room Remediation Requirements - in parallel with requirements validation, the team validates that
all Cisco HealthPresence rooms meet dimension, lighting, HVAC, power, network connectivity, and
noise-level requirements.
Network Path Assessment - The customer network and the links between sites are examined
in-depth to identify the optimal path and network requirements for the solution.
Detailed Design Development - A detailed design for the entire solution is created, including
recommendations for network components (switches and routers), network configuration
recommendations (e.g. security and QoS), CUCM and CTMS components, link speeds and other
related components that affect the efficiency and effectiveness of the Cisco HealthPresence
solution.
Network Implementation Plan - The implementation plan includes all configuration details,
including IP addresses, CUCM and CTMS configuration parameters, user IDs and passwords. The
implementation plan is then used to configure the Cisco HealthPresence components.
Solution Acceptance Testing - Once the solution is installed and configured the team performs a
Solution Acceptance Test that includes test cases for all sites to validate readiness of the solution
for live production.
Administrative knowledge transfer- The project team coordinates knowledge transfer to make sure
the system administrators, support staff, and end users all can make full use of the Cisco
HealthPresence technology.
Even when Cisco HealthPresence is deployed by trained professionals, enterprises still need ongoing
support and maintenance to safeguard all of the essential products included in the solution. Cisco
HealthPresence includes three service offerings to support and maintain the Cisco HealthPresence
solution components:
Cisco Healthpresence Custom Application Support - for the Cisco HealthPresence software
Cisco HealthPresence Application and Telemetry Support (ATS)
SMARTnet - for the other solution components from Cisco
Cisco HealthPresence Custom Application Support (CAS)
To maximize customer productivity, Cisco Healthpresence Custom Application Support provides timely
fixes to issues found in the Cisco HealthPresence code and ongoing software upgrades for minor releases
of Cisco HealthPresence. It also enables the customer to use a single point of contact to address any
issues with any of the components. This service is a Cisco Advanced Services Subscription offering and
it must be purchased with every Cisco HealthPresence License and be renewed annually.
Cisco HealthPresence Application and Telemetry Support Service
Cisco HealthPresence Application and Telemetry Support Service allows customers and their IT staff to
focus on their core business while Cisco provides proactive services to assure the resiliency of your
Cisco HealthPresence solution and all supported devices.
7-6
Configuration management component: Maintain an inventory of the Cisco HealthPresence solution
components and update the solution configuration as needed with a qualified support team. Help to
identify any issues that may impede adherence to regulatory requirements.
Change Management component: Manage network resiliency by assuring changes are made in a
manner that maximizes availability and performance while minimizing the impact on normal
business processes.
Incident Management component: Manage Tier-2 escalated incidents and problems to resolution
and closure on Cisco products in the Cisco HealthPresence solution. Review all complaints with
clinical implications and take any action required as a device manufacturer.
Cisco HealthPresence Application and Telemetry and Support Service is a required Cisco Advanced
Service Offering that must be ordered for every Cisco HealthPresence Endpoint and renewed annually
as long as the endpoints are in use.
Cisco SMARTnet
To complement Cisco HealthPresence Custom Application Support, Cisco SMARTnet provides
dedicated, system-level support and maintenance for all other Cisco components of the Cisco
HealthPresence solution voice and video, software and hardware. SMARTnet provides global
24-hour-day, 365-day-a-year access to highly skilled engineers, providing a comprehensive support
environment.
Cisco SMARTnet includes advance hardware replacement options with the option of onsite installation,
providing enterprises with parts delivery and replacement by the next business day or within four hours
on the same business day. The service also includes ongoing operating system and application software
updates, which strengthen the reliability, functionality, and stability of Cisco HealthPresence Solution.
In addition, companies gain registered access to an array of powerful, industry-leading online support
and information systems. These include interactive consulting tools, a comprehensive database, and
knowledge transfer resources available through Cisco.com. This robust set of Cisco technical tools and
product information increases the self-sufficiency and unified communications expertise of internal IT
staff, improving productivity while protecting the Cisco HealthPresence investment.
Cisco SMARTnet should be ordered and renewed annually (unless other service or parts replacement
strategy is in place) to ensure the high availability of the solution.
Cisco HealthPresence Solution Level Day 2 Support
There are three alternatives for Day 2 Service. One of the following strategies must be put in place for
every Cisco HealthPresence installation and kept in place as long as the Cisco HealthPresence Solution
is in use.
Cisco HealthPresence Remote Management Service (RMS)
Partner Delivered Day 2 Support Model
Customer Managed Day 2 Support Model
7-7
Cisco HealthPresence Remote Management Services (RMS)
While sound planning and ongoing support help enterprises quickly benefit from Cisco HealthPresence
technology, many organizations do not have the in-house Cisco HealthPresence expertise to optimally
remote monitor and manage the solution on a day-to-day basis. Developing that expertise can represent
a significant investment in time, people, and resources that can impede the operational efficiency of
in-house IT staff.
Cisco HealthPresence remote services provides 24x7 proactive remote monitoring and management
support for the solution to give enterprises greater peace of mind and allow internal IT administrators to
focus on core business requirements, instead of Cisco HealthPresence. The service combines all of the
components of the Cisco HealthPresence SMARTnet with world-class Remote Services from Cisco
Remote Management Services (RMS), including a redundant remote network operations center (NOC)
infrastructure that monitors the solution at all times and provides a single point of contact for rapid
service restoration.
RMS includes the following key deliverables:
Tier 1 Service Desk
Remote Monitoring and Management
Tier 1 Service Desk
The Tier 1 Service Desk triages issues and opens a case regardless of where the issue lies. If a problem
arises with the technology, enterprise IT administrators do not have to determine if the problem lies in
the voice, video, IP aspects of the solution, medical devices or Cisco HealthPresence-specific software.
Instead, this consolidated support model means that one telephone call connects administrators with
highly trained and experienced engineers who understand Cisco Unified Communications products and
technologies, Cisco HealthPresence components and who specialize in complex IP communications
environments. These engineers can diagnose an issue and, if necessary, facilitate collaboration across
multiple Unified Communications technology experts, third-party medical device experts
2
or Cisco
HealthPresence software experts to accelerate the resolution of any Cisco HealthPresence problem. This
system-level technical support can help enterprises quickly and cost-effectively resolve issues with any
aspect of the Cisco HealthPresence solution.
Remote Monitoring and Management
With remote monitoring and management services, Cisco engineers with in-depth expertise in managing
converged infrastructures provide ongoing proactive management, monitoring, reporting, and issue
diagnosis and remediation to proactively solve real-time incidents. Problems are followed through to
resolution and if necessary, replacement hardware is ordered per the existing agreements with either
Cisco SMARTnet or the medical device vendor. Remote monitoring ensures that the solution is highly
available and operating to its fullest potential. The enterprise retains ultimate control while Cisco
monitors the availability and performance of Cisco HealthPresence around the clock, proactively
identifying and resolving issues and collaborating with the IT team as needed.
Most issues are resolved before the user experience is ever affected. This extensive monitoring and
management helps deliver the highest level of customer satisfaction in terms of product reliability,
usability, and availability. As a result, enterprises can reduce the operational costs of supporting the
solution with in-house resources and help ensure that Cisco HealthPresence technology is available,
secure, and supporting business goals, consistent with the labeled and approved usage of Cisco
HealthPresence.
2. A valid third party support contract must be in place for third party devices.
7-8
Proper planning, expert ongoing support, and real-time remote management can all accelerate the
benefits of Cisco HealthPresence and give enterprises greater peace of mind using the solution. But what
can organizations do to help ensure that virtual presence sessions will always run smoothly? For
example, what if the person leading the session schedules an important conference incorrectly or needs
to make a change at the last minute and cannot remember how?
Remote Management Services offers real-time administrative support during Cisco HealthPresence
sessions. Users in any managed Cisco HealthPresence endpoint have access to remote assistance with
Cisco HealthPresence scheduling and Cisco TelePresence call setup. In addition, they can get answers
to questions about how to use the solution. As a result, users can quickly find answers and resolve
unexpected issues, and help ensure a smoother, more effective Cisco HealthPresence experience.
Cisco HealthPresence Partner Delivered Day 2 Support Model
This option is for Cisco partners who wish to offer Day 2 Support for the Cisco HealthPresence solution
to their customers.
As part of this support model, partners do the following:
Provide support for the Cisco HealthPresence solution and video components (i.e. Cisco
TelePresence)
Provide a Help Desk for Incident and Problem Tracking and Facilitation. They will escalate to the
Cisco Technical Assistance Center (TAC) or 3rd Party support as required.
Perform Level 1 Initial Triage (Cisco HealthPresence Solution-based support)
Perform Level 2 Video Support
Assess all reported issues to categorize customer service requests versus customer complaints
Escalate customer complaints directly to Cisco
Maintain incident records and adhere to Cisco's document retention policy: 5 years after the product
end of life date
As part of this support model, Cisco will:
Support partner-escalated Cisco HealthPresence solution issues and Cisco product issues
Perform Complaint Handling on partner-escalated customer complaints per regulatory guidelines
Train the partner on how to identify and report complaints to Cisco
Work with the Cisco Partner Channels Organization to perform periodic audits to ensure that Partner
is correctly identifying and reporting customer complaints to Cisco
Verify that Partner is maintaining records of all customer complaints
Cisco HealthPresence Customer Managed Day 2 Support Model
This option is for Cisco customers who wish to perform their own Day 2 Support for the Cisco
HealthPresence solution, using their own internal technical support team. The customer does the
following:
Provide Tier 1 (initial triage and troubleshooting) support for Cisco HealthPresence
Escalate issues to Cisco using SMARTnet and CAS contracts for entitlement
As part of this support model, Cisco will:
Provide Tier 2 support for customer-escalated Cisco HealthPresence solution issues and Cisco
product issues
7-9
Benefits
Perform Complaint Handling on customer-escalated complaints per regulatory guidelines
Manage actionable complaints per Cisco's Complaint Handling Procedure
Figure 7-4 compared the four Cisco HealthPresence Day 2 Managed Service Offerings.
Figure 7-4 Comparison of Cisco HealthPresence Day 2 Managed Service Offerings
Benefits
Cisco Services for Cisco HealthPresence provide a comprehensive set of activities that are essential to
the successful deployment and optimal ongoing operation of Cisco HealthPresence technology. The
Cisco HealthPresence Plan, Design, and Implement Service protects organizations against downtime
caused by improper solution design, helps enterprises avoid costly deployment delays, and helps ensure
that the solution fully meets expectations. Cisco HealthPresence Custom Application Support and
SMARTnet protect against downtime caused by hardware and software issues and provides critical
assistance and expertise to keep innovative Cisco HealthPresence solutions running smoothly. Cisco
HealthPresence RMS provides experts that focus on Cisco HealthPresence 24x7 so that users and
in-house IT administrators can focus on their business. Together, these services deliver a consistent,
high-quality Cisco HealthPresence experience and allow organizations to focus on transforming their
business not supporting technology.
Cisco Services for Cisco HealthPresence help organizations:
Accelerate the business benefits of Cisco HealthPresence by accurately assessing the effects of the
solution on the network and on physical locations, and addressing potential issues before they arise
Protect against downtime caused by improper infrastructure support or hardware and software issues
Decrease deployment times and avoid costly deployment delays, minimizing the risk associated
with adopting advanced technologies
Realize greater peace of mind through proactive remote monitoring and comprehensive operational
support and management of all elements of the Cisco HealthPresence solution, delivered through a
single, dedicated support environment
Transform business and technical requirements into a detailed design that can be implemented
efficiently and effectively and can provide a Cisco HealthPresence solution that meets expectations
Improve the performance and availability of the Cisco HealthPresence solution to better meet
business requirements and provide a robust foundation for supporting innovative communications
applications and intra-company collaboration
CiscoRMS
Solution
Support
Partner
Delivered
Customer
Managed
24x7ProactiveRemote
Monitoring
CISCO CUSTOMER PARTNER CUSTOMER
IncidentandProblem
Management
Level1/Tier1Support
Triage&InitialTroubleshooting
Level2/Tier2
Solutionlevelsupport
CISCO CISCO CISCO CISCO
ConfigurationandChange
Management
CISCO CISCO PARTNER CUSTOMER
7-10
Why Cisco Services
Why Cisco Services
Cisco Services make networks, applications, and the people who use them work better together.
Today, the network is a strategic platform in a world that demands better integration between people,
information, and ideas. The network works better when services, together with products, create solutions
aligned with business needs and opportunities.
The unique Cisco Lifecycle approach to services defines the requisite activities at each phase of the
network lifecycle to help ensure service excellence. With a collaborative delivery methodology that
joins the forces of Cisco, skilled network of partners, and customers, the best results are achieved.
For More Information
For more information about the Cisco Services for Cisco HealthPresence or other Cisco services, contact
your Cisco service account manager.

GL-1
OL-25099-01
G L O S S A R Y
Revised: November 16, 2011, OL-25099-01
A
AMD AMD Global Telemedicine
Attendant The licensed health care professional who attends the patient. This role includes greeting the patient,
taking the patients vitals, and using the medical devices to assist the Provider in evaluating the patient.
An Attendant can be a medical technician, a nurse, a nurse practitioner, or a physician.
Attendant Endpoint A Cisco HealthPresence endpoint from which the end user logged in as an Attendant. (To perform any
medical evaluations, the end user must be at an Attendant Station. In any case, the end user will be
presented the Attendant screens.)
Attendant Station The place where the patient and the Attendant meet. This area contains the medical device(s) used by
the Attendant, the video conferencing system, and the Cisco HealthPresence Connect Appliance. It may
also contain special furniture offered by Cisco.
B
B2B Business-to-Business
B2B Group A B2B Group is a group of business entities whose endpoints can participate in an appointment.
Business Entity In Cisco HealthPresence, refers to the resources (Attendant and Provider endpoints and users) managed
by a single Cisco HealthPresence Application Server.
B2B Feature The B2B feature enables consultation between endpoints belonging to different business entities. Each
business entity is managed by a single instance of Cisco HealthPresence.
C
CHP Admin See Cisco HealthPresence Administration.
CHP B2B Admin
See Cisco HealthPresence B2B Administration.
CHP B2B Manager
See Cisco HealthPresence B2B Manager.
CHP B2B Server
See Cisco HealthPresence B2B Server
CHP Portal See Cisco HealthPresence Portal.
CHPAS
See Cisco HealthPresence Administration.

Glossary
GL-2
OL-25099-01
Cisco
HealthPresence
Administration
The application used by the installation team to configure, administer and manage the CHPAS and the
CHP Portal.
Cisco
HealthPresence
Application Server
The Cisco HealthPresence component that maintains the master information of resources and manages
conferences, sessions and appointments. CHPAS interfaces with CHP Admin, CHP Portal, the EMR
integration engines, Unified Communications (UC) servers and the CHP Connect Server software at
the endpoints. For B2B appointments and conferences, CHPAS interfaces with the B2B Manager.
Cisco
HealthPresence B2B
Administration
The application used by the installation team to configure, administer and manage the B2B Manager.
Cisco
HealthPresence B2B
Manager
The application that manages conferences, sessions and appointments between endpoints residing in
different tenants.
Cisco
HealthPresence B2B
Server
The orderable software that includes the B2B Manager and B2B Administration.
Cisco
HealthPresence
Connect
The Cisco HealthPresence software that runs on the Appliance at both the Attendant and Provider
endpoints.
Cisco
HealthPresence
Connect Server
The orderable software that includes the Cisco HealthPresence Application Server, Cisco
HealthPresence Portal and Cisco Health Presence Administration.
Cisco
HealthPresence
Device
Refers to the Cisco HealthPresence components residing at an Attendant Station.
Cisco
HealthPresence
Endpoint
The collection of a video endpoint, the Cisco HealthPresence software and optional device aggregation
software running on a Cisco HealthPresence Appliance, and optionally the medical devices.
Cisco
HealthPresence
Appliance
A hardened PC that resides at either a Provider or Attendant station and runs the Cisco HealthPresence
Connect Client software and optionally the AMD device aggregation software.
Cisco
HealthPresence
Portal
The master portal that interfaces with the CHPAS and acts as a proxy for requests from the CHPPC. It
maintains the portal login sessions and provides interface for the CHPAS to validate sessions.
Cisco
HealthPresence
Solution
A solution the combines video, medical devices, computer networking and a graphical user interface
(GUI) to enable Providers to offer medical consultations to patients in a remote Attendant station.
Cisco TelePresence
Video
Communication
Server
A video server that provides Session Initiation Protocol (SIP) proxy and call control as well as H.323
gatekeeper services for video endpoints. The Cisco VCS Control application connects all
infrastructure, management, and endpoint devices and is critical to interoperability with unified
communications and IP telephony networks and voice-over-IP (VoIP) devices.

Glossary
GL-3
OL-25099-01
Cisco TelePresence
Multipoint Switch
Switches multipoint conference end points based on routing information that the CUCM servers
provide.
Cisco Unified
Communications
Manager
The application that extends enterprise telephony features and capabilities to packet telephony network
devices, such as IP phones and multimedia applications. Open telephony application interfaces make
possible services, such as multimedia conferencing and interactive multimedia response systems.
Codian MCU A multi-point control unit (MCU) used to switch video from Tandberg video endpoints.
CTMS See Cisco TelePresence Multipoint Switch.
CUCM See Cisco Unified Communications Manager.
CUVC Cisco Unified Video Communications
D
Default Region The region available on a fresh install that includes all the resources controlled by this CHPAS.
Customers who do not require partitioning of their resources to not have to configure additional
regions.
E
E- Pen Electronic Pen. Allows physicians to write online prescriptions.
Electronic Protected
Health Information
Any protected health information which is created, stored, transmitted, or received electronically.
ePHI Electronic Protected Health Information
H
HIPAA Health Insurance Portability and Accountability Act
Hosted In Cisco HealthPresence, refers to a software delivery model in which the Cisco HealthPresence
software and associated client data reside in a central location managed by a hosting service and
accessed by clients using a web browser.
M
Multi-point video
conferencing
Simultaneous video conferencing among 3 or more participants where video conferencing content
flows from the source through a multipoint control unit or switch and then is transmitted to two or more
recipients.
Multi-tenancy In Cisco HealthPresence, multi-tenancy refers to running multiple instances of the operating system,
databases and Cisco HealthPresence software on the same physical server (also known as Hardware
Virtualization).

Glossary
GL-4
OL-25099-01
P
PHI Protected Health Information
Provider A licensed medical professional who provides medical consultation in a Cisco HealthPresence
environment.
Provider Endpoint A Cisco HealthPresence Appliance from which the end user logged in as a Provider.
Provider Station A Cisco HealthPresence station designed for use by a Provider and consisting of a video endpoint and
the Cisco HealthPresence software running on the Cisco HealthPresence Appliance.
R
Region A subset of a endpoints and multipoint bridges controlled by a single Cisco HealthPresence Application
Server or Tenant. Dividing a Tenant into regions can help minimize latency when meeting resources
(that is, multi-point bridges or switches) are geographically dispersed, or to partition appointments
across multi-point bridges to balance workload.
T
Tenant An instance of the Cisco HealthPresence software run on a physical server in its own virtual machine.
TeleHealth The delivery of health-related services and information via telecommunications technologies.
Telehealth is an expansion of telemedicine, and unlike telemedicine (which more narrowly focuses on
the curative aspect) it encompasses preventive, promotive and curative aspects.
U
UC Unified Communications
User Profile Your User Profile determines which screens you see, and which functions you can perform. User IDs
are configured so that users with a particular role (or roles) see only the screens and options appropriate
to that job description. Any given user can have from one to five roles, or User Profiles, within one User
ID. The Site Administrator configures the User IDs.
V
VCS Video Communication Server
Vitals Patient data including: temperature, blood pressure, (blood) oxygen saturation and pulse.

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